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Y3 MOD Gastroenterology > Equine diarrhoea > Flashcards

Equine diarrhoea Flashcards

1
Q

Where is the major site of water absorption in the horse?

A

Large colon

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2
Q

Describe the normal faeces of a horse

A

Formed droppings
8-10 times / day
10-15kg / day
75% water

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3
Q

What is diarrhoea?

A

Increased volume / frequency and fluidity of faeces

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4
Q

Name the 5 mechanisms of diarrhoea

A
  • Malabsorption
  • Increased secretion
  • Osmotic overload
  • Abnormal motility
  • Extravasation of fluid (oedema)
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5
Q

How does malabsorption cause diarrhoea?

A

Loss of absorptive cells / tight junctions

Often inflammation

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6
Q

How does increased secretion occur which leads to diarrhoea?

A

Intracellular cAMP / Ca Bacterial exotoxins Inflammation

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7
Q

What are the causes of an osmotic overload?

A

Feeds / additives Malabsorption

e.g. Mag. sulphate

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8
Q

Where is acute diarrhoea in the horse localised?

A

Colitis

= inflammation of the colon or inflammation of the caecum and colon

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9
Q

Inflammation of the caecum and colon is termed?

A

Typhlocolitis

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10
Q

How is localisation of where diarrhoea occurs different in adult horses and foals

A 
In adults (not foals): colon very effective at absorbing water - LI is always affected, disease of only the SI does not cause diarrhoea
In foals: Diarrhoea can occur with just SI disease
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11
Q

Which substances are lost from the body with diarrhoea?

A

Water - dehydration
Electrolytes - electrolyte derangements
Protein - hypoproteinaemia

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12
Q

Which horses are affected by chronic diarrhoea?

A

All breeds

All ages

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13
Q

Describe chronic diarrhoea in horses

A
  • Any diseases that cause acute diarrhoea can progress to chronic diarrhoea
  • Many of the conditions considered for weight loss will also cause diarrhoea
  • In horses, diarrhoea will only occur if there is extensive colonic pathology
  • There can be colonic pathology without diarrhoea
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14
Q

What are some differential diagnosis for chronic diarrhoea in the adult horse?

A
  • Dietary causes: abnormal fermentation
  • Dental disease
  • Parasitism e.g. strongylosis
  • Sand ingestion
  • Antimicrobial associated
  • NSAID toxicity
  • Non-GI causes e.g. kidney, liver, heart
  • Neoplasia
  • Infiltrative disorders
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15
Q

Describe the information that should be gathered from a horse with chronic diarrhoea

A
  • management of the horse
  • normal diet and recent diet changes
  • exercise, travel, other causes of stress
  • deworming strategies and other concurrent therapies
  • history of recurrent episodes
  • diarrhoea in contact animals
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16
Q

What clinical signs might a horse with chronic diarrhoea show?

A
  • No/Mild dehydration
  • Bright/Eating well (NOT SIRS)
    +/- Weight loss
    +/- Polydipsia
    +/-Oedema
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17
Q

What needs to be ruled out if a horse is pyrexic? How?

A

Salmonella, Coronavirus (5 faecal samples for culture, PCR faeces /isolate till sure)

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18
Q

Which diagnostics can be carried out to help diagnose the cause of chronic diarrhoea?

A
  • Check for parasites
  • Check haematology and biochemistry for inflammation
  • Check plasma protein concentration
  • Peritoneal fluid
  • Ultrasound
  • Rectal biopsy
  • Absorption tests
19
Q

Name two parasites groups of horses that can cause diarrhoea?

A

Ascarids

Cyathostomins

20
Q

How can chronic diarrhoea be treated?

A
  • Treat underlying disease
  • Lavicidal deworm: Fenbendazole or ivermectin
  • Yeast/probiotic
  • Access to normal manure
  • Anti diarrhoea medications (usually ineffective long-term)
21
Q

What does SIRS stand for?

A

systemic inflammatory response syndrome

22
Q

What are some important causes of acute diarrhoea in horses > 9 months old?

A
  • Idiopathic* most common
  • Salmonella
  • Clostridia
  • Drug-induced: antibiotics
23
Q

What are some predisposing factors for acute diarrhoea?

A 
Antibiotic treatment
Transport
Competition
Hospitalisation
Surgery
ANY STRESS
24
Q

What are the two main presenting signs of a horse with acute diarrhoea?

A

Depression

Fever

25
Q

What are some other presenting signs in a horse with acute diarrhoea?

A 
Tachycardia (80-100 bpm)
Tachypnoea
Congested to purple mm’s
Slow CRT >2s
Anorexia
Dehydration
Reduced GI sounds
Colic
Diarrhoea
26
Q

What are 3 causes of fluid loss in acute diarrhoea?

A
  • Excess secretion due to inflammation + enterotoxins
  • Malabsorption
  • Loss of Na, Cl, K, bicarb and albumin
27
Q

Describe the pathophysiology of acute diarrhoea

A
  • Fluid loss
  • Mucosal inflammation, ischaemia and reperfusion injury
  • Breakdown of GI mucosal barrier
28
Q

Describe the pathophysiology of SIRS

A
  • Inflamed colon -> toxins (bacterial)
  • Go into the hepatic portal vein
  • Overwhelm normal mechanisms of clearance in the liver
  • Enter systemic circulation
29
Q

Which organs/tissues are affected by SIRS

A
  • Endothelium: thrombosis, phlebitis especially JUGULAR
  • Gastrointestinal
  • Integument: equine hoof laminae -> laminitis
  • Kidneys
30
Q

Name the infectious causes of acute diarrhoea

A
  • Salmonella
  • Clostridium perfringes and difficile
  • Coronavirus
31
Q

What is the source of infection of infectious acute diarrhoea?

A

Asymptomatic shedders or diseased horses

32
Q

Name some environmental and host stressors

A
  • High ambient temperature
  • Hospitalisation
  • Transport
  • Antibiotics
  • Gastrointestinal surgery
  • Immunosuppression
33
Q

What are the effects of cytotoxins?

A

Morphological damage and increase penetration of mucosa

34
Q

What are the effects of enterotoxins?

A

Increase sodium and water secretion

35
Q

Which clinical syndromes are linked to infectious diarrhoea?

A
  • Cytotoxins
  • Enterotoxins
  • Marked neutropaenia, hyponatraemia and dehydration
  • Septicaemia
36
Q

Describe antibiotic induced diarrhoea

A
  • Any antimicrobial
  • E.g. Mares with foals receiving erythromycin
  • Allows overgrowth of pathogens or poorly understood dysbiosis in colon
37
Q

What are the aims when taking a diagnostic approach to acute diarrhoea cases

A

Determine need for supportive therapy
Determine risk to in-contact horses:
- Salmonellosis: Faecal culture
- Clostridial: Cl. perfringens and difficile toxin assays
- Coronavirus: PCR
- ISOLATE till results are proven negative

38
Q

Describe the treatment approach for horses with acute diarrhoea

A
  • Determine need for fluid therapy
  • Determine hypovolaemia / dehydration
  • Assess electrolyte / albumin / acid-base status
39
Q

Describe the effects of increasing % dehydration on the body

A
  • Increasing HR
  • Increasing CRT
  • Increase in PCV and total protein
  • Increased creatinine
  • Dry mm, sunken eyes, signs of shock if severe
40
Q

How is existing volume deficit calculated?

A

% dehydration X body weight
Aim to replace over first 4-6 hrs (LRS)
Add: Colloids / plasma if hypoalbuminaemic

41
Q

Which solution should be given in a severe hypovolaemic case?

A

Hypertonic saline

42
Q

Describe some treatments for acute diarrhoea

A
  • Determine need for colloids
  • Determine need for additional electrolytes
  • Always offer electrolyte solutions as well as fresh water
  • Don’t forget to offer food
43
Q

Describe monitoring of a patient with acute diarrhoea

A
  • Repeat clinical assessments regularly
  • Monitor electrolyte concentrations
  • Cumulative fluid volumes per hour and per 12 and 24 hours essential to be calculated
44
Q

Describe supportive therapy for a horse with acute diarrhoea

A
  • Treat SIRS: NSAIDS
  • Ice feat against laminitis
  • Oral protectants

Y3 MOD Gastroenterology (3 decks)

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